In this episode, we speak with Dr. Judson Brewer about proven, concrete strategies to manage anxiety, including how to apply them for LSAT-related test anxiety and the stress of waiting for admissions results. Dr. Jud Brewer is a New York Times best-selling author, neuroscientist, addiction psychiatrist, and thought leader in the field of habit change. He is the director of research and innovation at Brown University’s Mindfulness Center, where he also serves as an associate professor of Behavioral and Social Sciences in the School of Public Health. He is the executive medical director of behavioral health at Sharecare and a research affiliate at MIT. Dr. Jud has developed and tested novel mindfulness programs for habit change, including treatments for smoking, emotional eating, and anxiety. He is the author of “Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind” and “The Craving Mind: From Cigarettes to Smartphones to Love, Why We Get Hooked and How We Can Break Bad Habits”.
Links to resources from Dr. Jud Brewer:
- Dr. Jud Brewer’s website
- Follow Dr. Jud Brewer on Instagram, Twitter and Facebook
- Unwinding by Sharecare (app)
- Unwinding Anxiety (app)
- Eat Right Now (app)
- Craving To Quit! (app)
Mike: Welcome to Status Check with Spivey, where we talk about life, law school, law school admissions, a little bit of everything. Today, I am joined by Dr. Jud Brewer, who is a psychiatrist, neuroscientist, and executive medical director of behavioral health at. He's also an Associate Professor of Behavioral and Social Sciences in the School of Public Health at Brown University and the Director of Research and Innovation at the Mindfulness Center at Brown.
It's a fascinating conversation, one of my most enjoyable and interesting to date, I think, as far as self-help and how you can alleviate — look, if you're waiting three months, five months for an admission decision, and the anxiety is building up, or if you're taking the LSAT in three months, or morning of and the anxiety has reached an all-time peak, Dr. Brewer is the go-to person for mitigation strategies, how to get rid of anxiety. We have a discussion — it's almost all centered around the efficacy and his research in overcoming anxious moments and more general longer periods of anxiety. He's a very down-to-earth guy, so I very much enjoyed this conversation, and without further delay, let me turn it over to Dr. Brewer.
Dr. Brewer, it's great to have you. I know you're tremendously busy and we have about 40 minutes. When we booked this podcast, I thought it might go in a different direction. We were coming out of COVID, things were looking good. All of a sudden there's these geopolitical dynamics, unlike anything I think you and I have ever seen in our lifetime, you know, almost like Cuban Missile Crisis era level. We're now maybe back into another COVID surge — who knows, hit or miss, I know they are in Europe and Asia. As a clinician, are you seeing not just like a linear, but an exponential increase in anxiety? And does this gel with sort of the, fear make sense from an evolutionary standpoint, but uncertainty is sort of a recent misfiring that is creating the levels of anxiety?
Brewer: Well, I would say, so — one, yes, we have seen a huge spike in anxiety. And I think we saw this at the beginning of the pandemic, and people started collecting data points along the way. We see a huge amount of, you know, the uncertainty that came with the first arrival of COVID-19. And then we saw all the waves. It's kind of like the shock waves of uncertainty, where it affects the economy, it affects our families, it affects schools. And then you get these other earthquakes, so to speak, that come later. Where it's the Delta earthquake and then all the variant earthquakes that come. And then we get earthquakes that come from misinformation around vaccines, you know, and all these uncertainties that get spat out into the world that are really hard for our brains to handle.
And so this piece around uncertainty and fear — uncertainty has and always will be a survival mechanism for us. Imagine our ancient ancestors, you know, they hear a rustling in the bushes. If they ignore it, probably not such a good idea, because it could be the tiger that's waiting to eat them. So, the problem is when we have uncertainty, and then we start projecting that into the future. That's where anxiety comes from. So, fear: very helpful survival mechanism. And if you look at it from an evolutionary perspective, it's also very interesting that we have our thinking and planning brains, the newest part of the brain, the prefrontal cortex, you know, it's really supposed to be very good at thinking and planning. But when you mash those two together — fear as a survival mechanism, thinking and planning — we get fear of the future. And that fear of the future is actually an anti-survival mechanism. Because the more afraid we are, the harder it is for us to think. We're kind of in fight or flight mode.
So, as our brain thinks, “What about this? What about this? What about this?” we spin out into worry, to dread, to fear, which actually just makes it harder for us to survive. Anxiety is really, you know — it's not shown to be evolutionarily adaptive for us as much as the internet might say, “Oh, some levels of anxiety are good.” There's no actual data that supports that.
Mike: So, my understanding also is, because the prefrontal cortex is sort of a newer part of our brain, not only can we not just rely on it, but when we're tired, stressed, hungry, whatever, we're going to revert to the old part of our brain. Our go-to is the reptilian part, the survival part, the fear part.
Brewer: I know, I even learned — in residency I learned probably many folks know this acronym, HALT, for my patients with addictions. When they're hungry, angry, lonely, or tired, they're most vulnerable to relapse. And we're all vulnerable to relapse. Whether it's yelling at our spouse or stress eating or whatever, you know, it's that thinking and planning part of the brain that says, “Oh you shouldn't, but I'm going to do it anyway.” You know.
Mike: For some reason that reminds me of your dictionary definition of anxiety, which is anything in the imminent future, which is uncertain. Well, that's everything. I should be anxious about brushing my teeth. So, I mean, it seems like anxiety is probably pervasive, but I'll give you an example. For COVID, I sort of instinctively fell into this “freaking growth opportunity.” You know, if you read David Goggins I would probably use a swear word there, but “freaking growth opportunity.” And that was me for COVID. Like I just dove into your research and about 50 other people, Dr. Dweck from Stanford, you know, the people we've had on our podcast, Lembke, Gabor Maté, Dr. Guy Winch. But now with the geopolitical uncertainty, it's harder for me to dive into anything. It's not like I just had this social isolation time. The news is just saying how horrible the world is. Is there a comparison between the first situation, the global pandemic, which to me seemed like a slower buildup than the situation with Ukraine and Russia?
Brewer: Well, I think the speed is one example of a potential difference here. So, if we think of how our brains learn, the most rewarding type of learning is called Intermittent Reinforcement. It's what the casinos use for slot machines, which basically means random reward. You don't know when you're going to get the payout. And if you look at the news — and I'm sure folks were doing this at the beginning of the pandemic, but I think folks are doing it even more now at the speed of this Ukrainian situation. Where with the pandemic, it took a while for things to unfold. We had the sequence that, you know, we're watching the spread, all that stuff. But with this, with the human types of things, things can happen pretty quickly. Somebody could push a button that could be mass destruction for a lot of people. It doesn't take a lot of time for that to happen.
So, if you look at the news feeds, our brains are saying, “Uncertainty, I got to see what's up.” And we don't know when a new news headline is going to hit. And we don't know when some big event's going to happen. So, it's easy to get really locked into the newsfeed where our brain says, “Uncertainty, I got to keep updated. I got to keep updated.” And then randomly, there's going to be an update in terms of some news story that hits. Our brain hits the dopamine jackpot, says, “Oh, good thing you checked every five minutes.” Because three hours later there was actually a news story.
It's much easier to get addicted to the news feeds, and also, I don't know if this is fair to say, but viruses evolve at a certain pace. We can watch their evolution based on certain conditions. People aren't quite as logical in their evolutionary process as viruses are. We are more prone to being impulsive, especially people that are angry or isolated or afraid, or who knows what some of the people in power right now are doing or not doing or thinking or not thinking, because they're working from their fear mechanisms.
Mike: Right, it kind of reminds me, I watched you on Rich Roll, I'm a big fan of his podcast. And you were talking about how, like, his mother, a mother with a new teenager, staying up from 10:00 P.M. to 3:00 A.M., just, you know, restless, worrying, waiting to hear the door unlock, knowing that their child is home safe. Well, that worrying isn't making that child any safer. Me, watching the news — and you kind of nailed it, me watching the news, waiting for that dopamine jackpot because, “Oh my god, breaking! There's a peace talk negotiation scheduled.” I'm not enabling that to happen.
Brewer: Right. It's not because you watch the news that they scheduled a peace talk.
Mike: Right. So, we'll get to things that can help our listeners then, since I don't think any of us can really help the geopolitical landscape.
Let's talk about performance anxiety. When I was in my doctoral program, my research area was goal setting. And it shows how old I am, I can't even remember, but this is like around 1998. And the literature is still that stress and worry can be performance enhancing. (Laughs) I can see your face, our audience can’t. The bigger piece of literature that really stuck in my mind was that grit, motivation is a muscle. And yes, that muscle gets depleted, but Spivey you're doing this work in goal setting, and that's like an electrolyte for the muscle of willpower: set proximal, attainable, but difficult goals, and you're going to reenergize that motivation muscle. But my understanding now is, maybe all that literature has been replaced by new research, which is, no, we don't even have that muscle.
Brewer: Yes. And I think you can separate some of these things out. So, I think if you look at goal setting, for example, and I'm not the expert here, so I’m going to give you some baseless speculation and BS based on my understanding of it. If you look at how our brains work, for example, we prefer smaller rewards immediately over larger rewards later. Those data are very, very solid. It's called delayed discounting, temporal discounting, all this work has been done, Bickel and others, really, really solid work there. And so it makes sense if you set a small goal for an immediate timeframe as compared to a large goal later, that can tap right into that. I think those data probably aren't going to change. That makes a lot of sense, and it fits with the evolutionary biology and all of that.
But if you look at the willpower piece, it's been controversial for decades. When you look at the meta-analysis, when people look at all the different studies and try to make sense of them, it roughly comes out at 50/50. It's still at chance whether a study is going to be positive or negative. Which also fits with, if you look at a correlation, you know, if you test let's say willpower depletion, or ego depletion as some of these researchers talk about it, you could get a result and it could be true, as in you get a result, and it could have everything or nothing to do with willpower. It's basically chance. So, you could look at it that way and say, well, nobody's nailed it yet, and there have been plenty of studies that have been done. So, why haven't the data come out more one way or the other? If it's chance, it's probably going to stay at 50%.
If you look at the mechanisms behind how our brains work, that — to me, I'm a biased because I'm a neuroscientist — but it's a little more convincing. If you look at how habits change, it has nothing to do with willpower. It's not in the equation. When we calculate out changes in reward value, for example, which is the most studied way to look at how people change behavior — this has been studied in rodents, it’s been studied in monkeys, it's been studied in humans, and these formulas go back to the ‘70s, so, it's not like this is some brand-new thing — but it just gets reinforced. The reinforcement learning mechanisms get reinforced. If you look at them over and over and over, they're pretty solid, and they’ve nothing to do with willpower. Willpower is not part of the equation. The equation has everything to do actually with paying attention to how rewarding the process is, which makes sense. It’s called reward-based learning for a reason. If something's rewarding, we're going to keep doing it. If it's not rewarding, we're going to stop.
And I'll say, in my labs, we have this app called Eat Right Now, where it helps people pay attention if they're overeating, if they're stress eating, if they're emotional eating, whatever, it helps them change that behavior. And in one of the studies we just published, we could actually look at the change in reward value, and that change happens relatively quickly. We have this thing called the craving tool, where people can pay attention as they crave a certain type or amount of food. And we can have them pay attention as they overeat. We find that it only takes 10 to 15 times of somebody paying attention as they overeat for that reward value to drop, ready for this, below zero. Below zero. And they start shifting their behavior. So, that has nothing to do with willpower and has everything to do with how our brain works.
So, I think there is some updating in terms of the willpower literature and the theory, based on some of the modern neuroscience. And we and other labs are showing, you know, this seems to be a pretty clear way forward in terms of changing behavior.
Mike: This is clearly overly basic, but the efficacy of sort of that equation, that intervention seems to be, I'm just going to quote one study from yours, three times as much as efficacious as say, giving someone an SSR, 1 in 5 versus 60%.
Brewer: Yeah, we've had pretty solid data. So, for example, one of the studies, I think you're quoting — we have this app called Unwinding Anxiety to help people with generalized anxiety disorder, for example. And we got a 67% reduction in anxiety, so that's pretty solid. There aren't really any medications that give, on a population level, that level of success. With the Eat Right Now App, there was a woman, Ashley Mason, who led a study at UCSF of our app and found a 40% reduction in craving related eating. So, certainly more studies need to be done always, and, you know, pretty solid start. And my sense is, you know, if you target the mechanism, you're more likely to get a positive, significant result.
Mike: Yeah. Just for the listeners, we're going to link your apps in the show notes for this so they can take advantage of this. Speaking of listeners, so, our typical listener may be different than some of the podcasts you've been on, 60 Minutes. 18 to 26. When I was 18 to 26, I wouldn't be listening to a podcast. So, kudos to them looking inward versus at the external world. Our typical listener maybe is waiting three months to hear back from a college or a law school or medical school. Did I get admitted? And in today's world three months is as, you know, a lifetime.
Brewer: Yeah. It's glacial.
Mike: Or “intolerable,” is the word that comes to mind, to me. Or they have to take the LSAT in three months. For someone who is anxious, is it the same anxiety taking the LSAT in three months as that morning, or the day where it peaks, is that the same pathways? And if you were talking to someone who I talk to every day, “Hey Spivey, I’m freaked out because the LSAT’s today,” or “Hey Spivey, I'm starting to get nervous because I have three months to study for it,” what would your advice to that person be, how to calm the anxiety?
Brewer: Yes, well, I would say there are two levels that depend on what's happening that day, for example. But the advice is pretty similar.
So, the first thing I would say is, well, the best way to study for anything is to have your brain fully online. I don't think that's in dispute, right? If you look at Carol Dweck's work, Growth Mindset, you've got to be open, and anxiety causes people to close down. Makes a lot of sense to really optimize the conditions for learning. So, here, if somebody's freaked out, they're kind of closed down, they’re in survival mode. That's not a great time to try to study. In fact, that can make it harder to study, because if we try to force ourselves to study and we can't be taking that information in, or we're taking practice exams and bombing the questions, that can just freak us out even more, and then it just spirals. So, it's really important to be able to ground ourselves first.
So, that's the first thing I would say, is find some practices that can really help you ground yourself. I've got some on my YouTube Channel. We have some in our Unwinding Anxiety app, you know. But the basic premise is, find something that can really ground yourself. One of my favorites is Five-Finger Breathing. It's on my YouTube Channel; I won't go into the details. But basically, it's a way to help people pay attention to four things at once. It kind of fills up their working memory part of their brain so that anxious thoughts get jettisoned, you know. It's kind of like rebooting your RAM of your computer. And then when you're calmed down a little bit, the anxious thoughts come back in, and there's a mismatch between the emotional intensity of the thoughts where your brain's saying, “I'm anxious,” and then your body's feeling calmer. And you're saying, “Well, I'm not really feeling anxious.” And that can break that cycle. When the two are synchronized, you know, when our brain's like, “I'm anxious,” and our body's like, “Yeah, I'm anxious,” then they just start feeding off of each other. And it's a feeding frenzy in terms of driving anxiety.
So, being able to calm the body, knowing that the body, that feeling body — let's think of it this way, the feeling body is much stronger than the thinking brain. So, we can't think our way into calm. “Just stop worrying” — It doesn't work that way. I wish. You know, it'd be easy. My clinic would be very simple.
Mike: You'd be out of a job.
Brewer: Yeah. I'd be happily be out of a job, find something else to do. So, the first thing to do is calm ourselves. And then the second thing I would say that's really important, is to really take some time, I would say, invest energy in yourself. It's amazing how people don't want to invest time or even energy or whatever into themselves, understanding how their own minds work. That's the best investment I ever made, was really starting to learn how my mind works. And so I would say invest in learning how your mind works. It's worth that time, because it can help you optimize just about every aspect of your life. You know I think of it as, it helps us get out of our own way. And that is a really efficient way and actually a much more joyful way to go through life.
So I write about it in the Unwinding Anxiety book, or the Unwinding Anxiety app has this three-step process, but you don't need any of those. I'll just walk people through it.
You know, the first step is mapping out these habit loops there around anxiety or worry. The second step actually taps into something I mentioned earlier, which is checking in with how rewarding it is. If it's not rewarding, if we can see that worrying isn't actually helping us study, our brains naturally start to become disenchanted with that. That's that reward value piece that's changing. And then the third step, which is, I think, a supercharged way to help study, which is to tap into our natural capacity to be curious. I think of that as giving our brains a bigger, better offer. If you compare worry to curiosity, which one feels better? Curiosity wins every time.
Mike: The curiosity one I get excited about. Hey, I'm just a naturally curious person, so it makes me feel pretty good. Do you know, I think it’s Daniel J. Levitin is the author's name, he's a neuropsychologist.
Brewer: He wrote a book, right?
Mike: Yes, Successful Aging, and I read it. I just turned 50 and I'm like, I better start aging successfully. People with what he calls “CQ,” as to differentiate from IQ or EQ, tend to live the longest. So, the more curious you are, equates with longevity.
Brewer: I love that. I will have to go look that up. Hopefully there are studies that he quoted in his book, because I want to read those. Oh I'm so curious. That makes so much sense.
Mike: If I have the study, I'll zap it over your way.
Mike: Do you want to take the exercise of habit loops and mind mapping and take an example of either mine or a friend of mine, you get to pickm and do this for our listeners to see what it's like?
Brewer: Yeah, let's do it. Let's roll up our sleeves. And I would say, I'm curious you pick whichever one you'd like, I'll do either one.
Mike: Mine is very complicated and nebulous to me. Although listening to your book maybe helped me understand it a little bit better. My friend’s is very pervasive because it has to do with social media. So, it's really up to you. Do you want a complicated nebulous one or do you want a very universal one?
Brewer: Let's start with your friend, and if we've got time let's do yours as well.
Mike: Okay, that sounds good. So, a friend of mine lives in Boulder, Colorado. As you know, I live in the mountains where everyone mountain bikes up here. She used to visit the mountains all the time, and she started following this page on Instagram called the I-70, which is the highway, as you know, that comes out here. Now it's a major highway — and of course the Department of Transportation is probably going to sue me after this podcast; it’s not their page! — because a page of all the semi-trucks, you know, plowed off the road, tipped over in the snow, or all the six-hour traffic lines that get to Vale or Aspen to ski, and every day there's a new picture of that. So, here's how I visualize it. Trigger — please tell me if I'm wrong. Trigger: she signs on, she sees a picture. It's never a happy person going 70 miles per hour. So, behavior: she stays home. She doesn't come up to the mountain. I use the word “result” more than reward.
Brewer: Yeah, I like that too.
Mike: Okay, good! So, result is that she's now at home doing nothing but looking at her freaking I-70 Instagram page more, which is just that whole habit.
Brewer: Yeah. That is a pretty straightforward. And I'm sure folks, whether they subscribe to that one or not, are now curious and they go subscribe to it, or have their own social media habit loops. We can see how these simple things can literally drive our lives or cause us not to drive somewhere that might actually be rewarding.
So, here, if I were talking to your friend, the first thing we do is map it out, and it sounds like you've mapped it out pretty nicely. So, the trigger is like, “Oh, let me see if the highway is crowded.” Let me make sure I've got this right. You know, “Let me see if I-70 is busy, and I'll go drive up into mountains for a mountain bike or a hike.” The behavior is to go check Instagram and see some traffic jam. And then the result of that is to say, “Well, screw it. I'm not going to go today.” And of course, the Instagram account is probably still up and so she might even check later and be like, “Oh, did I make the right decision?” You know, it’s “Oh, it cleared up right after I decided not to go,” whatever. And so we can get that buyer’s remorse as an echo habit loop. Am I getting that right?
Mike: Yeah. I mean, I think you nailed it. What I’d encourage her to do is be curious about why she even wants to look at those pictures.
Brewer: Yes. So, here, if she were to ask me for advice, how to break that habit loop, there are a number of things that she could explore. One is to see what she's getting from not going. So, what's the result? That's what drives future behavior. And so if that result is that it just, every time she does that, it freaks her out more and it keeps her from going to do her thing, then she could start to ask herself, what am I getting from this? You know, is this really helpful? And then, the next things she can do — our brains love comparisons; they’re always going to compare things and pick that bigger, better offer as I like to think of it. She could say, “Well, what was it like the last time when I actually did go, how did it feel?” I imagine, when I've been mountain biking in Colorado, epic!
Mike: Yeah, yeah. Rad or epic are the two words that it would be!
Brewer: So, just comparing those two, we can ask ourselves, is it worth the risk to just get in the car and go? You know, maybe there's some traffic, whatever. But we can look at the result of when we've actually done it. What is “epic” versus “oh crap.” It's a no-brainer.
Mike: So, I'll refer back to you somehow. The success rate of — I can say her name, she’s given me permission — of getting Kelsi back to epic adventures. I think we have about 11 more minutes. Do you want to hear mine?
Brewer: I would love to.
Mike: I don't even know where to begin. For whatever reason, I have a lot of people close in my life who are doctors, MDs, and also therapists. But I’m connected on many levels. The friend doctors of mine tell me, “Hey, you're super calm, particularly during a crisis.” We've been talking about this because of your book and this podcast. “Don't worry about a thing, man. The more stressful the time, the calmer you get.” My doctor, who I respect the world out of and who I see for 50-year-old physical ailments, like a yearlong stress fracture — I walk into his office, and you're going to laugh, because this is probably like the last thing a doctor ever wants to hear. But it's always, “So, I was on Google reading about a stress fracture in your talus, how that's the worst place for it to be.” That's the first thing I'm saying. And I can almost sense him like texting his staff, “Prescribe 50 mg Zoloft stat.” So, I have this weird bifurcation of medical friends telling me I'm super calm, and my doctor saying, “You have intense generalized anxiety disorder.” I'm going to posit that's not surprising to you.
Brewer: Yeah. It's not surprising at all. If you look at immediate threat, when we're under immediate threat, we don't have time to worry. In fact, worrying and Googling is kind of a first world problem, where we have the luxury — think of it that way — we have the luxury to worry. And in fact, studies have been done across the world, and I'm not sure, first world and third world are probably old terms, so let's just say a Western or even a US-centric problem, where there's more anxiety in the US than in other places of the world. And if you look at the amount of time that we have to worry and to Google things, it tends to be more than in other places.
And so imagine, with increasing stress, like you're talking about like, if your house is burning down, you're not going to go and Google, “Best way to call 911.” You're just calling 911. You're doing what you need to do. You're running out of the house. You're probably staying calm. You're doing the right things. That's very different than fear of the future, because it's fear of what's happening right now.
So, fear can drive us in a way that can really focus us in a very helpful survival way. Whereas, if you're sitting in the waiting room of your doctor, and especially if your doctor's running late or whatever, you have plenty of time to Google, like, how bad is this? And then you bring all those worries, especially worries about the future — how long is this going to take to heal? Oh, this, this, this — you bring all that in, and that all that's fear of the future. You're not sure if — a stress fracture is a fracture, but it's not like you're imminently in danger of dying right now.
Mike: Right. My doctor is always late because he is a listener. He really listens to his patients, which is what I adore about him. So, he spends a lot of time, but there is that waiting period. And I don't think on a given day I’m an anxious person/I’m always anxious. I think it's good for doctors to know this, because I suspect this is not just me. When you're sitting in that waiting room, and like you said, the stress fracture's not going to kill me, two-pound weight gain isn't going to kill me. All that stuff, if we can provide any insight for the medical community, everyone in that waiting room is getting more and more anxious.
To me, I think of it as helplessness puts me in a state of anxiety. I don't know when that stress fracture — I can't do anything about it. But things that I can problem solve, work issues, don't put me in a state of anxiety, and my guess is that's pretty common too.
Brewer: It is. And if you look at it that way, where you don't have control — we don't have control over the future, as much as we'd like to. We can certainly plan for the future, but we can't guarantee anything. We can base it on probabilities. So, the more we worry about something in the future, especially the less information there is, ironically the less control we have over it, the more that worry can really ramp out of control.
Mike: Yeah. The calmest guy I've ever met in my life was my doctoral statistics professor. We would always joke if the plane was going down, he would still be saying, “There's a 99.9% chance they're going to correct this problem.” I guess that's to your point of being curious enough to know the statistics.
Wrapping things up, I have some theories of why you've been so successful, why so many people listen to you. We actually were tipped off onto your book by someone who was talking to us on a Zoom call about her application process. She was waiting so long. She found your book and that helped her. The way you speak to people in your book is put in terms that are understandable, so that's number one. Number two, I wish we could talk for five hours on this but you can't, is you tie together things that we had Dr. Lembke and Dr. Maté on the show talk about, which I think you're onto something. I don't think we have this E=MC2 equation yet for addiction, but I think we're getting there. And I think there's an anxiety component where anxiety might be an addiction, and this is all just part of that loop. Would you agree with that?
Brewer: Well, I would. The theory has been pretty solid for decades, back to Thomas Borkovec and others, and also our own data. You know, there's nothing like science and reproducibility. You know, we've run three clinical studies now where we've tested the theory of treating anxiety, like a habit loop, and we've gotten gangbuster results. I mentioned the one with generalized anxiety disorder. We did a study with anxious physicians. We got a 57% reduction in these clinically validated scores. So it's really nice to see the science back up our theories. It's not like it’s my theory, I'm just testing these other theories. But I hadn't actually learned about anxiety as a habit loop in medical school or residency. And it was just because I study habits in my lab that it kind of came together, especially as I was struggling to help my own patients with anxiety. And to see it in my clinic where my patients are profoundly changed, and to see it in our studies where on a population level we're seeing big reductions, that's pretty convincing, at least to me.
Mike: When I got to the part of your book where you talked about physicians, that made me want to go hug all my physician friends. The thing about “armoring up” made sense. I'm guessing, when you're a young physician, the last thing you want to do is like show your anxiety. All you're doing is taking on someone else's. I loved how you said, as a physician now, often you'll sit and listen. Just listen. And that matters. That's an intervention itself.
Brewer: It does. It does. One of my favorite things that I learned in residency, one of the little quips was, “Don't just do something, sit there.”
Mike: Yeah, you said that in the book. It reminds me of the David Foster Wallace’s quote, I won't get it word for word, but, sometimes people just need to sit and hurt, sometimes just listening to someone hurt.
The third and final thing we'll end on is the reason why I think your research is so compelling to me, is your reliance on repeated more science, more data. My favorite study ever, I'm going to guess you haven't heard this. It's like 20 years old. I think I heard it on NPR, I don't think I have the brain capacity to make this up, but I'm only 99.9% sure I heard this. They took psychologists as a population sample, but they also took psychologists who were wine aficionados, wine connoisseurs. They just thought that they were part of the study for being wine connoisseurs. They were giving the really high-end wine in paper cups, and the really like cheap wine in glass with white linen, dressed up waiter. You could predict what happened. The crappy wine was the good wine, says the connoisseur, that was what they predicted.
Here's what they didn't predict. These are psychologists, the most trained people on the planet to understand subjectivity and biases. When they told these people, you're also a psychologist, we’re curious your reaction, a critical mass of them said, “Oh, I get the study now, but you messed up my study. You gave me the good wine in the good glass.”
Brewer: No kidding.
Brewer: Oh, that's hilarious.
Mike: So, I'm going to try to find that, because it's been years ago, but it sounds to me like a lot of what you do in your practice, but also in your research with functional MRIs, is you're trying to test yourself to make sure you're not misleading yourself and saying the bad wine is in the bad cup.
Brewer: Yeah, I have to say, I love this quote from Richard Feynman, who's this physicist who wrote these fabulous short books about his life. One of them was called Surely Your Joking, Mr. Feynman! Great books. And he had this saying where he said, “As a scientist, you must not fool yourself. You are the easiest person to fool.” When we believe a theory, we stop being a scientist. It's really about testing a theory, not believing it. And so for me, as a scientist, I want to really stay as curious as possible, and love the questions, and love the answer no matter what the answer is, as compared to rooting for one answer or another. But more importantly, as a physician, as a clinician, my patients depend upon me to really do the right thing. I don't care what's the best thing, I just need to find out what that best thing is. So we've developed some programs ourselves, because I haven't been super excited about the current treatments, and a lot of them haven't really targeted the mechanisms. So we've had to create those ourselves, but even then, we test them, and we don't blind ourselves and say, “Oh, it must work.” I want to know how it works and how well it works so I can make it even better. And that's what drives me. That's what drives my curiosity is like, how can we make it even better?
Mike: And you have a new book coming out.
Brewer: Well, I'm working on a new one.
Mike: Okay, we won't talk too much about it, but hopefully if that makes it better, when it's out, if you want to come back on the podcast, you're more than welcome to. If you want to explain to me the Feynman paradox, I still don't quite understand it, but I have read his books too. So it was wonderful having you. Any final thoughts for our listeners on anxiety?
Brewer: Well, I'll just say, don't downplay the power of curiosity. It can be so helpful. Not only for helping us ground ourselves and let go of the anxiety, step out of those anxiety cycles, but also it can help us be open to learning, whether it's studying for a test or an exam or getting into a school or just loving life. So, here's to curiosity. That's what we'll end on.
Mike: It's freaking growth opportunity. Thank you so much for your time, Dr. Brewer. It was a great pleasure.
Brewer: My pleasure.